Continuation versus discontinuation of renin-angiotensin aldosterone system inhibitors before non-cardiac surgery: A systematic review and meta-analysis.

J Clin Anesth

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine, AdventHealth, Sebring, FL, USA. Electronic address:

Published: December 2024

Background: A large number of patients undergoing noncardiac surgeries are on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). The current guidelines regarding the continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting. This meta-analysis aims to evaluate whether continuing or withholding RAAS inhibitors before noncardiac surgery influences perioperative mortality and complications.

Methods: A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to August 30, 2024 to identify eligible randomized controlled trials (RCTs) and cohort studies. Clinical outcomes were evaluated using a random-effects model to pool odds ratios (ORs) with 95 % confidence intervals (CIs).

Results: The analysis included 16 studies with a total of 59,105 patients on RAAS inhibitors before noncardiac surgery. Withholding RAAS inhibitors was associated with a significantly lower incidence of intraoperative hypotension (OR = 0.49; 95 % CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI = 0.82 to 0.95) than continuing the therapy. However, there was no statistically significant difference in reducing mortality (OR = 1.10; 95 % CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR = 1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI = 0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between the two groups.

Conclusion: Withholding RAAS inhibitors before noncardiac surgery reduces intraoperative hypotension and AKI with nonsignificant effects on mortality and MACE.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2024.111679DOI Listing

Publication Analysis

Top Keywords

raas inhibitors
20
inhibitors noncardiac
16
noncardiac surgery
16
withholding raas
12
inhibitors
8
system inhibitors
8
intraoperative hypotension
8
95 %
7
surgery
5
noncardiac
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!